RESUMO
BACKGROUND: The intricate mechanisms of jowl formation, which ultimately lead to loss of lower jaw definition, skin laxity, and localized fat accumulation, involve interrelated factors such as skin aging, fat redistribution, muscle dynamics, and loss of support. AIMS: To propose a structured approach to the treatment of the jowl area that is comprehensive and tailored to the needs of each individual patient. MATERIALS AND METHODS: This integrative review combines a meticulous analysis of the literature with practical insights from real-world clinical settings. The authors draw on their extensive clinical experience to bridge research findings with practical clinical perspectives. RESULTS: This study presents a guideline for addressing jowl formation that starts with the major aging processes and, based on simple diagnostic questions, suggests minimally invasive interventions, including collagen stimulators, energy-based devices, lipolytic injectables, polydioxanone threads, and hyaluronic acid fillers. DISCUSSION: The guideline emphasizes the significance of personalized treatments while also acknowledging the need for comprehensive evaluation and recognizing the ever-evolving nature of aesthetic interventions in jowl management. CONCLUSION: This systematic approach can not only simplify diagnostic and treatment decisions for dermatologists but also enhance patient satisfaction by customizing treatment plans based on individual characteristics and expectations.
Assuntos
Técnicas Cosméticas , Rejuvenescimento , Envelhecimento da Pele , Humanos , Envelhecimento da Pele/efeitos dos fármacos , Técnicas Cosméticas/normas , Preenchedores Dérmicos/administração & dosagem , Preenchedores Dérmicos/efeitos adversos , Guias de Prática Clínica como Assunto , Satisfação do PacienteRESUMO
In Mexico there is a proliferation of "centers for aesthetic medicine" that offer different treatments with laser beam, mesotherapy and hyaluronic acid and botulinum toxin injections. In numerous centers of this type, offered and performed by medical personnel that are neither trained or certified to ensure the quality of services. The National Academy of Medicine of Mexico and the National Normative Council for Medical Specialties (CONACEM) communicate their posture on this matter.
En México existe una proliferación de "centros de medicina estética" que ofrecen tratamientos diversos con rayos láser, mesoterapia, ácido hialurónico e inyecciones con toxina botulínica por personal médico que no está capacitado ni certificado para asegurar la calidad de los servicios. La Academia Nacional de Medicina y el Comité Normativo Nacional de Consejos de Especialidades Médicas (CONACEM) comunican su postura al respecto.
Assuntos
Técnicas Cosméticas , Estética , Academias e Institutos , Toxinas Botulínicas/administração & dosagem , Técnicas Cosméticas/normas , Humanos , Ácido Hialurônico/administração & dosagem , Terapia a Laser/métodos , Mesoterapia/métodos , MéxicoRESUMO
LEARNING OBJECTIVES: After reading this article and watching the accompanying videos, the participant should be able to: 1. Assess patients seeking facial volumization and correlate volume deficiencies anatomically. 2. Identify appropriate fillers based on rheologic properties and anatomical needs. 3. Recognize poor candidates for facial volumization. 4. Recognize and treat filler-related side effects and complications. SUMMARY: Facial volumization is widely applied for minimally invasive facial rejuvenation both as a solitary means and in conjunction with surgical correction. Appropriate facial volumization is dependent on patient characteristics, consistent longitudinal anatomical changes, and qualities of fillers available. In this article, anatomical changes seen with aging are illustrated, appropriate techniques for facial volumization are described in the setting of correct filler selection, and potential complications are addressed.
Assuntos
Materiais Biocompatíveis/administração & dosagem , Técnicas Cosméticas , Preenchedores Dérmicos/administração & dosagem , Face , Injeções Subcutâneas/métodos , Envelhecimento da Pele , Tecido Adiposo/transplante , Envelhecimento , Apatitas/administração & dosagem , Materiais Biocompatíveis/efeitos adversos , Tomada de Decisão Clínica , Colágeno/administração & dosagem , Contraindicações , Técnicas Cosméticas/normas , Técnicas Cosméticas/tendências , Preenchedores Dérmicos/efeitos adversos , Combinação de Medicamentos , Educação Médica Continuada , Face/patologia , Face/cirurgia , Humanos , Ácido Hialurônico/administração & dosagem , Injeções Subcutâneas/instrumentação , Tamanho do Órgão , Poliésteres/administração & dosagem , Polimetil Metacrilato/administração & dosagem , Ritidoplastia/métodos , Ritidoplastia/normas , Ritidoplastia/tendências , Transplante AutólogoRESUMO
Introduction: Mammoplasty is one of the most common plastic surgeries in Brazil. Among the surgical techniques described in the literature, the areolar inferior pedicle technique is the most significant because of its versatility, safety, and satisfactory aesthetic results. This study avaluated cases of mammoplasty with the areolar inferior pedicle technique performed by the author, and to propose a small change in the attachment of the pedicle to the pectoralis major muscle. Methods: A total of 74 patients underwent the surgery from June 2007 to December 2014. Results: The average patient age was 35.63 years; the mean body mass index was 25.8; and the mean follow-up duration was 28 months. Complications occurred in 33.76% of the cases, and the average amount of resected tissue was 585 g. The degree of satisfaction was excellent or good in 93% of the cases. The sensitivity of the areolar-papillary complex (APC) was maintained in 72% of left-breast reconstructions and 77% of right-breast reconstructions. Moreover, there was a complete loss of sensitivity in 3% of left-breast cases. Conclusion: The use of mammoplasty with the areolar inferior pedicle was versatile and safe, and produced favorable outcomes. In addition, the sensitivity of the APC was adequately maintained. Further studies might confirm the importance of the change in fixation of the pedicle suggested in this study.
Introdução: A mamoplastia é uma das cirurgias plásticas mais realizadas no Brasil. Dentro do universo de técnicas descritas, destaca-se o pedículo inferior areolado por sua versatilidade, segurança e bons resultados estéticos. O estudo avalia os casos de mamoplastia pela técnica do pedículo inferior areolado realizados pelo autor e apresentar uma pequena modificação na forma de fixação do pedículo ao músculo peitoral maior. Métodos: Foram avaliadas 74 pacientes operadas no período de junho de 2007 a dezembro de 2014. Resultados: A idade média das pacientes foi de 35,63 anos, o índice de massa corporal médio foi 25,8 e o tempo médio de seguimento, de 28 meses. Complicações ocorreram em 33,76% dos casos, a quantidade média de tecido ressecado foi 585 gramas. O grau de satisfação foi ótimo ou bom em 93% dos casos. Houve manutenção da sensibilidade do complexo areolopapilar (CAP) em 72% das mamas à esquerda e 77% à direita. Em 3% das mamas à esquerda houve perda completa da sensibilidade. Conclusão: A mamoplastia pelo pedículo areolado inferior mostrou-se neste estudo versátil, segura e com bons resultados. Além disso, houve boa manutenção da sensibilidade do CAP. Estudos posteriores poderão ratificar a importância da modificação na fixação do pedículo sugerida neste trabalho.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , História do Século XXI , Pacientes , Músculos Peitorais , Complicações Pós-Operatórias , Cirurgia Plástica , Mama , Redução de Peso , Técnicas Cosméticas , Mamoplastia , Procedimentos de Cirurgia Plástica , Pacientes/psicologia , Músculos Peitorais/cirurgia , Complicações Pós-Operatórias/cirurgia , Cirurgia Plástica/métodos , Mama/cirurgia , Técnicas Cosméticas/normas , Satisfação do Paciente , Satisfação do Paciente/estatística & dados numéricos , Mamoplastia/métodos , Procedimentos de Cirurgia Plástica/métodosRESUMO
INTRODUCTION: Skin disorders associated with photodamage from ultraviolet light include wrinkles, hyperpigmentation, tactile roughness, and telangiectasia, and are more common in people with white skin compared with other skin types. Wrinkles are also associated with ageing, hormonal status, smoking, and intercurrent disease. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for skin wrinkles? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 33 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: botulinum toxin injection (e.g., botulinum toxin type A and type B), carbon dioxide laser, chemical peel (including alpha and beta hydroxyl acids), dermabrasion, isotretinoin, tazarotene, tretinoin, and variable pulse erbium:YAG laser.
Assuntos
Técnicas Cosméticas/normas , Envelhecimento da Pele , HumanosRESUMO
O tratamento cirúrgico apresentado neste artigo tem inovações táticas e torna o procedimento pouco agressivo. O objetivo é demonstrar uma maneira diferente de executar a suspensão do terço médio da face. O procedimento é realizado com agulhas semicirculares tipo Stocchero, com passagem de fio de náilon 2.0 no plano subcutâneo, na altura da borda anterior da glândula parótida, e fixação do fio na fáscia temporal. Foram operados com emprego desse método 49 pacientes, com obtenção de bons resultados estéticos. Em um paciente, houve necessidade de executar uma cicatriz pré-auricular, para acomodação da pele. O método é seguro, simples, não necessita de internação hospitalar, evita uma cicatriz pré-auricular e o resultado oferece boa satisfação aos pacientes.
The surgical treatment presented here involves technical innovations, making it a less-aggressive procedure. The goal is to demonstrate a different way of executing a suspension of the skin in the medial third of the face. The procedure is performed with semi-circular Stocchero needles with the passage of a 2-0 nylon thread through the subcutaneous plane at the anterior edge of the parotid gland and fixation to the temporal fascia. A total of 49 patients were operated on using this method with good aesthetic results. One patient required a pre-auricular incision to accommodate the skin. This method is safe, simple, does not require hospital inpatient admission, avoids a pre-auricular scar, and provides satisfactory results.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , História do Século XXI , Glândula Parótida , Rejuvenescimento , Instrumentos Cirúrgicos , Ritidoplastia , Técnicas Cosméticas , Procedimentos de Cirurgia Plástica , Estética , Face , Agulhas , Glândula Parótida/cirurgia , Rejuvenescimento/psicologia , Instrumentos Cirúrgicos/normas , Instrumentos Cirúrgicos/ética , Ritidoplastia/métodos , Técnicas Cosméticas/normas , Procedimentos de Cirurgia Plástica/métodos , Face/cirurgia , Agulhas/normas , Agulhas/éticaRESUMO
INTRODUCTION: Body image has always preoccupied people across time and cultures. Today, the search for beauty can be fulfilled with high-power technologies that are relatively easy to use, such as Class 3b and Class 4 lasers and intense pulsed light (IPL) sources. Lasers are devices that amplify light, emitting it in a narrow, coherent optical beam; the beam produced is near-monochromatic, the particles all move in the same direction, and the waves are in phase with one another. Intense pulsed light is based on different physical and technological principles. Unlike lasers, IPL sources emit polychromatic light (non-coherent, between 500 and 1,200 nm), and selected wavelengths are obtained by means of filters. These technologies are used for various cosmetic purposes and applications, including some that clearly come under activities reserved to physicians, while others fall into the grey areas surrounding medicine. Based on the definitions of the different fields of medical activity and on the laws and regulations governing the practice of medicine, this report has limited its scope to examining laser and IPL procedures that do not require medical diagnosis and that may be performed in Québec by operators other than physicians or health professionals, without medical supervision. This report does not purport to determine what does and does not lie within the scope of medicine. Rather, it focuses on the risks inherent in these technologies and on the qualifications required to use them, by taking hair removal as a base case and by dealing more briefly with skin resurfacing and tattoo removal, without ruling on the field of activity to which these practices belong. RESEARCH METHODS: Medline (National Library of Medicine) via PubMed and the Cochrane Library were searched. The grey literature was also examined to take into account the contextual aspects that prompted the request for this report, especially the legal and regulatory provisions framing the use of lasers and IPL by non-physician operators in various countries and regions. In addition, local experts were consulted to validate the contextual evidence and the applicability of the ensuing recommendations. These experts are key actors in the following organizations: Association des dermatologistes du Québec; Collège des médecins du Québec; Comité sectoriel de la main-d'Åuvre des services de soins personnels [sector committee on personal services workers]; Ministère de l'Éducation, du Loisir et du Sport; Ministère de l'Emploi et de la Solidarité sociale; and Ministère de la Santé et des Services sociaux. CONCLUSION: Analysis of the scientific and contextual evidence leads to these findings: Class 3b and Class 4 lasers and IPL sources are high-power technologies entailing risks for operators and their customers. The use of these technologies leads to adverse effects that, although minor and transient for the most part, may in some cases be serious; however, scientific evidence does not allow us to determine their frequency or severity, or to link them with the types of professionals using them. Some cosmetic procedures may overlap with activities reserved to physicians when these. procedures are applied to areas of the skin with an underlying medical condition or with the risk of complications requiring medical expertise. Current Canadian safety standards regulate the sale and importation of these devices and their use in health-care facilities, and the safe use of lasers is governed by laws and regulations intended to protect workers' health and safety in all work settings. However, Québec has no law or regulation to protect the health and safety of the public undergoing laser or IPL procedures in non-medical settings. The use of Class 3b and Class 4 lasers and IPL sources is widespread in beauty care centres, but the specific types of devices used are not known. There is no professional order regulating the practice of estheticians or other types of personnel working in the personal services sector and likely to use laser or IPL devices, and the Office des professions du Québec has already denied the application by the Association des électrolystes du Québec to establish a professional order. The Comité sectoriel de la main-d'Åuvre des services de soins personnels and the Ministère de l'Éducation, du Loisir et du Sport have already developed their own non-mandatory vocational training programs in laser hair removal, but these programs do not cover other cosmetic laser applications or the use of IPL. The Act respecting Workforce Vocational Training and Qualification (R.S.Q., c. F-5) could fill this regulatory gap in part by standardizing the required occupational skills, establishing vocational training and qualification programs, and determining occupational eligibility requirements for laser or IPL operators working in non-medical settings. In light of these findings, this report is not able to rule either on the safety of laser or IPL procedures by non-physician operators working without medical supervision or on the scope of activities that could be authorized to them in the Québec context. However, given that these technologies present hazards and may lead to adverse effects that are potentially serious when used for cosmetic procedures, and given that there is a serious possibility of interference with the field of medicine, AETMIS has reached the following conclusions, which define the major issues to be dealt with: The boundary between the procedures restricted to the field of medicine and the cosmetic procedures that may be performed by non-physician operators must be clearly established.
Assuntos
Humanos , Técnicas Cosméticas/normas , Terapia de Luz Pulsada Intensa/normas , Centros de Embelezamento e Estética , Técnicas Cosméticas/efeitos adversos , Terapia de Luz Pulsada Intensa/efeitos adversos , Fatores de Risco , Avaliação da Tecnologia Biomédica/normasRESUMO
INTRODUCTION: Body image has always preoccupied people across time and cultures. Today, the search for beauty can be fulfilled with high-power technologies that are relatively easy to use, such as Class 3b and Class 4 lasers and intense pulsed light (IPL) sources. Lasers are devices that amplify light, emitting it in a narrow, coherent optical beam; the beam produced is near-monochromatic, the particles all move in the same direction, and the waves are in phase with one another. Intense pulsed light is based on different physical and technological principles. Unlike lasers, IPL sources emit polychromatic light (non-coherent, between 500 and 1,200 nm), and selected wavelengths are obtained by means of filters. These technologies are used for various cosmetic purposes and applications, including some that clearly come under activities reserved to physicians, while others fall into the grey areas surrounding medicine. Based on the definitions of the different fields of medical activity and on the laws and regulations governing the practice of medicine, this report has limited its scope to examining laser and IPL procedures that do not require medical diagnosis and that may be performed in Québec by operators other than physicians or health professionals, without medical supervision. This report does not purport to determine what does and does not lie within the scope of medicine. Rather, it focuses on the risks inherent in these technologies and on the qualification
Assuntos
Humanos , Técnicas Cosméticas/efeitos adversos , Técnicas Cosméticas/normas , Terapia de Luz Pulsada Intensa/efeitos adversos , Terapia de Luz Pulsada Intensa/normas , Fatores de Risco , Análise Custo-Benefício , Centros de Embelezamento e EstéticaRESUMO
INTRODUCTION: Mesotherapy is widely used In Latin America for cosmetic purposes, particularly in obese individuals. We describe the clinical and epidemiological characteristics, microbiological diagnosis, treatment and follow-up of patients from Caracas (Venezuela) with soft tissue infection caused by non-tuberculous mycobacteria following mesotherapy. METHODS: Between March 2002 and December 2003, we evaluated 49 cases of skin and soft tissue infection following mesotherapy. Specimens obtained from the lesions and 15 products used in the mesotherapy procedure were cultured for the presence of non-tuberculous mycobacteria. Isolated mycobacteria were identified by PCR restriction fragment length polymorphism analysis of the hsp65 gene. RESULTS: Infection by non-tuberculous mycobacteria was confirmed in 81.6% of the 49 cases. Mycobacterium abscessus and M. fortuitum were the most common species, but M. chelonae, M. peregrinum, M. simiae and a new species that was designated "M. cosmeticum" were also isolated. Patients were treated with species-specific antibiotic agents for 3 to 18 months. Investigation into the source of the infection revealed that 21 patients were clustered within 3 different outbreaks and two products were found to be contaminated with M. fortuitum and M. abscessus, respectively. CONCLUSIONS: Physicians should be alerted to the possibility of infection by non-tuberculous mycobacteria in patients with a history of mesotherapy who develop late-onset skin and soft tissue infection, particularly if they do not respond to conventional antibiotic treatment.